Provider Demographics
NPI:1558416669
Name:HODGE, JILL CAMPBELL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CAMPBELL
Last Name:HODGE
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:1313 CAROLINA ST STE 100
Mailing Address - Street 2:LING & KERR PEDIATRIC THERAPY
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6001
Mailing Address - Country:US
Mailing Address - Phone:336-370-4070
Mailing Address - Fax:336-370-9008
Practice Address - Street 1:1313 CAROLINA ST STE 100
Practice Address - Street 2:LING & KERR PEDIATRIC THERAPY
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6001
Practice Address - Country:US
Practice Address - Phone:336-370-4070
Practice Address - Fax:336-370-9008
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC3747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12124OtherBCBS
NC7411509Medicaid
NYA4947OtherMEDCOST